Altered phosphate metabolism in myocardial infarction: P-31 MR spectroscopy

The high-energy myocardial phosphate metabolism of four patients with acute anterior myocardial infarction after coronary angioplasty and drug therapy was evaluated with cardiac-gated phosphorus magnetic resonance (MR) depth-resolved surface coil spectroscopy (DRESS) 5-9 days after the onset of symptoms. Significant reductions (about threefold) in the phosphocreatine (PCr) to inorganic phosphate (Pi) ratio and elevations in the Pi to adenosine triphosphate (ATP) ratio were observed in endocardially or transmurally derived MR spectra when compared with values from epicardially displaced spectra and values from seven healthy volunteers (P less than .05). High-energy phosphate metabolites and Pi ratios did not vary significantly during the cardiac cycle in healthy volunteers. However, contamination of Pi resonances by phosphomonoester components, including blood 2,3-diphosphoglycerate, precluded accurate spectral quantification of Pi and pH. The results indicate that localized P-31 MR spectroscopy may be used to directly assess cellular energy reserve in clinical myocardial infarction and to evaluate metabolic response to interventions.     

Raised Coulter mean corpuscular volume in diabetic ketoacidosis, and its underlying association with marked plasma hyperosmolarity

An abnormal and transient increase of the Coulter mean red cell volume (MCV) was observed in four of 10 patients with diabetic decompensation. A sequential study of haematological and biochemical measurements in these patients revealed that this phenomenon was associated with the hyperosmolar state. The proposed mechanism and the clinical implications of this change are briefly discussed.     

Incorporation versus infection of retroperitoneal aortic grafts: MR imaging features

The magnetic resonance (MR) imaging characteristics of normal aortic graft healing were compared with those of perigraft infection in 57 patients after aortic graft implantation. Thirty-three patients without postoperative complications underwent MR imaging in a 0.35-T unit 1 week after graft implantation, and 13 of those patients were reexamined 2-3 months after graft implantation. Twenty-four patients with clinically suspected perigraft infection underwent MR imaging 6 weeks to 18 years after graft implantation. Early normal postoperative changes were characterized by a perigraft collar of low to medium signal intensity on T1-weighted images and of high intensity on T2-weighted images in all 33 cases, consistent with perigraft fluid collection. In 10 of 13 patients reexamined 2-3 months postoperatively, the MR images demonstrated a collar of tissue consistent with perigraft fibrosis. In cases of clinical suspicion of retroperitoneal graft infection, MR imaging showed eccentric fluid collections of low to medium signal intensity on T1-weighted images and high intensity on T2-weighted images at more than 3 months after surgery. The MR findings were diagnostic of retroperitoneal perigraft infection in 17 of 20 patients shown to be infected at surgery. Retroperitoneal infection was correctly excluded on the basis of MR findings in four patients. Thus, MR imaging is an accurate imaging method for the diagnosis of aortic graft infection. In the early postoperative phase, resolving perigraft fluid cannot be differentiated from perigraft infection.     

Lymphoma: evaluation with Ga-67 SPECT

To determine the value of gallium-67 single photon emission computed tomography (SPECT) in imaging patients with lymphoma, the authors compared Ga-67 planar images and SPECT images in 40 consecutive patients, using radiologic examinations and/or medical records to confirm the presence or absence of disease. Thirty-three patients had Hodgkin disease, and seven had non-Hodgkin lymphoma. Fifty-four examinations were performed. Of 57 sites of lymphoma in the chest, planar imaging depicted 38, while SPECT depicted 55, resulting in sensitivities of 0.66 and 0.96 for planar and SPECT imaging, respectively. In eight sites, both modalities were truly negative, but SPECT was negative in four additional sites that were equivocal on planar imaging, resulting in specificities of 0.66 and 1.00 for planar and SPECT imaging, respectively. In the abdomen, the sensitivities of planar and SPECT imaging were 0.69 and 0.85, and the specificities 0.87 and 1.00, respectively. SPECT was more accurate in depicting foci of gallium-avid lymphoma in the chest and abdomen and in excluding disease when planar imaging was equivocal.